Senna glycoside

Constipation and surgery medication

Pharmaceutical compound

Senna glycoside

Clinical data
Trade names| Ex-Lax, Senokot, others[1]
AHFS/Drugs.com| Monograph
MedlinePlus| a601112
License data|

* US DailyMed: Senna

Pregnancy
category|

* AU: A[2]

Routes of
administration| Oral, rectal
ATC code|

* A06AB06 (WHO)

Legal status
Legal status|

* UK: P (Pharmacy medicines)
* US: OTC
* In general: Over-the-counter (OTC)

Pharmacokinetic data
Onset of action| Minutes (by rectum), 6 to 12 hours (orally)[3]
Identifiers

IUPAC name

* 9-[2-carboxy-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracen-9-yl]-4-hydroxy-10-oxo-5-[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-9H-anthracene-2-carboxylic acid

CAS Number|

* 66575-30-2 Y

PubChem CID|

* 5199

DrugBank|

* DB11365 Y

ChemSpider|

* 65892 N

KEGG|

* D02171

Chemical and physical data
Formula| C42H38O20[4]
Molar mass| 862.746 g·mol−1
NY (what is this?) (verify)

Senna glycoside, also known as sennoside or senna, is a medication used to treat constipation and empty the large intestine before surgery.[1][5] The medication is taken orally (swallowed by mouth) or via the rectum.[1][6] It typically begins working in around 30 minutes when given by rectum and within twelve hours when given orally.[3] It is a weaker laxative than bisacodyl and castor oil.[1]

Common side effects of senna glycoside include abdominal cramps.[3] It is not recommended for long-term use, as it may result in poor bowel function or electrolyte problems.[1] While no harm has been found to result from use while breastfeeding, such use is not typically recommended.[1] It is not typically recommended in children.[1] Senna may change urine to a somewhat reddish color.[1] Senna derivatives are a type of stimulant laxative and are of the anthraquinone type.[1] While its mechanism of action is not entirely clear, senna is thought to act by increasing fluid secretion within and contraction of the large intestine.[1]

Sennosides come from the group of plants Senna.[3] In plant form, it has been used at least since the 700s AD.[7] It is on the World Health Organization's List of Essential Medicines.[8] It is available as a generic medication.[1][6] In 2022, it was the 280th most commonly prescribed medication in the United States, with more than 600,000 prescriptions.[9][10] In 2022, the combination with docusate was the 261st most commonly prescribed medication in the United States, with more than 1 million prescriptions.[9][11] It is sold under a number of brand names including Ex-Lax and Senokot.[1]

## Medical uses

[edit]

Senna is used for episodic and chronic constipation though there is a lack of high-quality evidence to support its use for these purposes.[5] It may also be used to aid in the evacuation of the bowel prior to surgery or invasive rectal or colonic examinations.[12][13]

### Administration

[edit]

Oral senna products typically produce a bowel movement in 6 to 12 hours. Rectal suppositories can act within minutes or take up to two hours.[14]

## Contraindications

[edit]

According to Commission E, senna is contraindicated in cases of intestinal obstruction, acute intestinal inflammation (e.g., Crohn's disease), ulcerative colitis, appendicitis, and abdominal pain of unknown origin.[12]

Senna is considered contraindicated in people with a documented allergy to anthraquinones. Such allergies are rare and typically limited to dermatological reactions of redness and itching.[12]

## Adverse effects

[edit]

Adverse effects are typically limited to gastrointestinal reactions and include abdominal pain or cramps, diarrhea, nausea, and vomiting.[12]

Regular use of senna products can lead to a characteristic brown pigmentation of the internal colonic wall seen on colonoscopy. This abnormal pigmentation is known as melanosis coli.[14]

### Interactions

[edit]

Senna glycosides can increase digoxin toxicity in patients taking digoxin by reducing serum potassium levels, thereby enhancing the effects of digoxin.[15]

## Mechanism of action

[edit]

The breakdown products of senna act directly as irritants on the colonic wall to induce fluid secretion and colonic motility.[16]

## Pharmacology

[edit]

They are anthraquinones derivatives and dimeric glycosides.[17]

## Society and culture

[edit]

### Formulations

[edit]

Senna is an over-the-counter drug available in multiple formulations, including oral formations (liquid, tablet, granular) and rectal suppositories. Senna products are manufactured by multiple generic drug makers and sold under various brand names.[13]

### Brand names

[edit]

Ex-Lax, Geri-kot, Perdiem Overnight Relief, Senexon, Pursennid, Senna Smooth, Senna-Gen, Senna-GRX, Senna-Lax, Senna-Tabs, Senna-Time, SennaCon, Senno, Senokot.[12]

## References

[edit]

1. ^ a b c d e f g h i j k l American Society of Health-System Pharmacists (1 January 2008). "Senna". Drugs.com. Archived from the original on 6 September 2015. Retrieved 11 August 2015.
2. ^ "Prescribing medicines in pregnancy database". Therapeutic Goods Administration (TGA). Australian Government, Department of Health and Aged Care.
3. ^ a b c d Navti P (2010). Pharmacology for pharmacy and the health sciences : a patient-centred approach. Oxford: Oxford University Press. p. 337\. ISBN 9780199559824. Archived from the original on 5 March 2016.
4. ^ "Senna(Powdered)". PubChem. U.S. National Library of Medicine.
5. ^ a b Wald A (January 2016). "Constipation: Advances in Diagnosis and Treatment". JAMA (Review). 315 (2): 185–91\. doi:10.1001/jama.2015.16994. PMID 26757467.
6. ^ a b Hamilton RJ (2010). Tarascon pharmacopoeia (2010 ed.). Sudbury, Mass.: Jones and Bartlett. p. 181\. ISBN 9780763777685. Archived from the original on 5 March 2016.
7. ^ Khare CP (2004). Indian Herbal Remedies Rational Western Therapy, Ayurvedic and Other Traditional Usage, Botany. Berlin, Heidelberg: Springer Berlin Heidelberg. p. 133\. ISBN 9783642186592. Archived from the original on 5 March 2016.
8. ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
9. ^ a b "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
10. ^ "Sennosides Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
11. ^ "Senna; Docusate Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
12. ^ a b c d e Lexicomp Online, Lexi Drugs Online, Hudson, Ohio: Lexi-Comp, Inc.; 17 April 2014.
13. ^ a b Drugs.com "Senna (Professional Patient Advice)". Archived from the original on 19 April 2014. Retrieved 17 April 2014.
14. ^ a b McQuaid KR (2012). "Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases.". In Katzung BG, Masters SB, Trevor AJ (eds.). Basic & Clinical Pharmacology (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
15. ^ "Senna: MedlinePlus Supplements". Archived from the original on 6 April 2015.
16. ^ Sharkey KA, Wallace JL (2011). "Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease.". In Brunton LL, Chabner BA, Knollmann BC (eds.). Goodman & Gilman's The Pharmacological Basis of Therapeutics (12th ed.). New York, NY: McGraw-Hill. Archived from the original on 19 April 2014. Retrieved 18 April 2014.
17. ^ Franz G (October 1993). "The senna drug and its chemistry". Pharmacology. 47 (Suppl. 1): 2–6\. doi:10.1159/000139654. PMID 8234429.

* v
* t
* e

Drugs for constipation (laxatives and cathartics) (A06)

Stool softeners|

* Docusate

Stimulant laxatives|

* Bisacodyl
* Bisoxatin
* Cascara
* Castor oil
* Dantron
* Oxyphenisatine
* Phenolphthalein
* Senna glycosides
* Sodium picosulfate

Bulk-forming laxatives|

* Dietary fiber
* Ethulose
* Ispaghula
* Methylcellulose
* Polycarbophil calcium
* Sterculia
* Triticum
* Syrup of figs

Lubricant laxatives|

* Liquid paraffin
* Mineral oil

Osmotic laxatives|

* Lactitol
* Lactulose
* Laminarid
* Magnesium carbonate
* Magnesium citrate
* Magnesium hydroxide (milk of magnesia)
* Magnesium oxide
* Magnesium peroxide
* Magnesium sulfate
* Mannitol
* Pentaerythritol
* Polyethylene glycol (macrogol)
* Sodium phosphate
* Sodium sulfate
* Sodium tartrate
* Sorbitol

Enemas|

* Bisacodyl
* Dantron
* Glycerol
* Oil
* Sodium laurilsulfate
* Sodium lauryl sulfoacetate
* Sodium phosphate
* Sorbitol

Opioid antagonists|

* Naloxone (Oxycodone/naloxone)
* PAMORAs
* Alvimopan
* Axelopran
* Bevenopran
* Methylnaltrexone
* Naldemedine
* Naloxegol

Others|

* Linaclotide
* Lubiprostone
* Oxyphenisatine
* Plecanatide
* Prucalopride
* Tegaserod
* Tenapanor
* Ulimorelin

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*[UK]: United Kingdom
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